Adolescent methamphetamine abuse remains a significant public health problem in the United States, with more than 6% of high school seniors in 2004 reporting having used the drug. Studies have shown that prevalence is higher in rural areas. Researchers performing two randomized, controlled trials found that when universal substance abuse intervention programs-which target the general population-focused on reducing factors that contribute to drug use, they delayed the start of and reduced methamphetamine use in adolescents in rural Iowa. (Results of both studies were published in one report.)
In one study, sixth-grade students (98% white) from 33 schools were randomized to a "minimal-contact" control group or to participate in either the Iowa Strengthening Families Program (ISFP) or the Preparing for the Drug Free Years program (PDFY). Both interventions are family-based, multisession programs involving parents and students. When surveyed in 12th grade, the 148 students in the ISFP group who completed follow-up reported no methamphetamine use within the previous year. Those in the PDFY group and control group had use rates (3.2% and 3.57%, respectively) comparable to those found in national surveys.
In the second study, seventh graders (99% white) from 36 other schools in Iowa were randomized in a similar fashion: to a "minimal-contact" control group or to one of two intervention groups, the Life Skills Training (LST) program by itself or the LST program plus the Strengthening Families Program for Parents and Youth 10 to 14 (SFP 10-14 + LST). Those in the dual-intervention group, at follow-up in the 11th grade, had the lowest rate of methamphetamine use (0.53%) in the past year. Those in the LST-only group reported more use (2.51%), and those in the control group had the highest rate (4.15%). In grade 12, the rates had gone up in both intervention groups, to 2.12% in the SFP 10-14 + LST group and 1.44% in the LST-only group. In the control group, the rate was 4.59%. (None of these differences reached statistical significance.)
The rates of lifetime use at grade 12 in both intervention groups (2.63% in the SFP 10-14 + LST group and 2.4% in the LST-only group) were significantly lower than that in the control group (7.61%).
Fran Mennick, BSN, RN
FROM THE NATIONAL INSTITUTE OF NURSING RESEARCH
NPs Are Effective Case Managers
Cardiac patients lower cholesterol level with help of NPs.
Patients with coronary heart disease (CHD) can decrease their risk of a major cardiovascular event or death by lowering their level of the harmful low-density lipoprotein (LDL) cholesterol, and case management by an NP can cost-effectively help those patients achieve reductions. NPs at a Maryland medical center followed a group of CHD patients with elevated LDL cholesterol levels for one year after hospitalization for a coronary bypass or balloon procedure. The 228 patients averaged 60 years of age, and most were male and white. An NP met with each of the 115 patients randomized to the experimental group within six weeks of discharge for counseling on lifestyle and diet changes and prescription of lipid-lowering drugs according to an established protocol. NPs also ordered laboratory tests for blood lipid levels and recommended adjustment of the dosage based on those tests. At one year, patients in the intervention group had decreased their LDL cholesterol level by an average of 40%. Over the year, the NPs spent approximately five hours counseling each patient during outpatient visits and by telephone. The total cost per patient for the NP's salary, laboratory tests, and medications was $39 per percent reduction in LDL cholesterol. These findings indicate that an NP-managed program both effectively and cost-effectively helps CHD patients lower cholesterol levels.
Paez KA, Allen JK. J Am Acad Nurse Pract 2006;18(9):436-44.